Motor vehicle and violent injuries predict future firearm injuries in children

Motor vehicle and violent injuries predict future firearm injuries in children | Image Credit: © nilsversemann - stock.adobe.com.

Children and adolescents who present to the emergency department (ED) with motor vehicle crash or violent injuries are at significantly increased risk of future firearm injuries, according to new research presented at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition in Denver, Colorado.^1,2

The study, Associational Analysis for Pediatric Firearm Injury Risk, examined injury patterns over 4 years in a large Midwest pediatric health system. Researchers found that nearly 1 in 4 children with firearm injuries had previously been treated for either a motor vehicle crash injury or another violent injury.

“As a pediatric emergency physician, I see firsthand how trauma doesn’t happen in isolation,” said senior author Mike Levas, MD, professor of pediatrics at the Medical College of Wisconsin and medical director of Project Ujima at Children’s Wisconsin. “Our study reveals a troubling pattern: nearly 1 in 4 children with firearm injuries return to the emergency room with another violent or crash-related injury within just 4 years. These aren’t random events—they’re interconnected.”

Study design

Researchers conducted a retrospective analysis of ED visits between January 1, 2018, and December 31, 2022. The study population included patients aged 0 to 17 years who presented with firearm injuries, non-firearm violent injuries, or motor vehicle crash injuries.

The analysis included descriptive statistics, chi-squared tests, and correlation analyses to evaluate the associations between injury types. Logistic regression modeling was then used to identify predictive factors for firearm injury at a third ED encounter.

Key findings

The study reviewed 2,614 ED visits during the study period. Findings revealed:

• Repeat injuries: 23.6% of children with firearm injuries had more than 1 encounter for firearm, violent, or motor vehicle crash injuries.
• Association: There was a statistically significant association between motor vehicle crash injuries and subsequent firearm injuries (χ² (1, n=2614) = 9.683).
• Predictive factors: Regression models identified five predictors of firearm injury at a third ED encounter: age, first encounter motor vehicle crash injury, first encounter acuity, second encounter violent injury, and second encounter acuity.
• Risk escalation: Each worsening in acuity score at the first encounter increased the risk of firearm injury twelvefold. A violent injury at the second encounter was associated with a tenfold increased risk of firearm injury at the third encounter.

Clinical and community implications

These findings underscore the interconnected nature of childhood injuries and point to the need for early intervention. “Our community health teams work closely with kids and families to understand their experiences, alongside clinical teams who have robust information at their fingertips through a patient’s medical history and are repeatedly treating kids for these injuries,” said study author Maria Beyer, community health evaluation manager. “Together they share observations and compile evidence, setting the stage for the kind of statistical modeling we were able to achieve through this study.”

Researchers emphasized that identifying risk patterns can help direct limited resources toward children most at risk for firearm injuries. Partnerships between healthcare providers and community organizations may also help bridge gaps, improve continuity of care, and connect families with support systems that reduce the likelihood of repeat injuries.

The authors noted that future research should focus on integrating risk stratification into clinical practice, developing best practices for early intervention, and expanding hospital-based violence prevention programs.

Conclusion

The study highlighted the opportunity to use prior injury encounters, particularly motor vehicle crashes or violent injuries, as predictors of firearm injury risk in children and adolescents. By recognizing patterns early, pediatricians and emergency physicians may help prevent future injuries and deaths.

“These findings will help inform ways to prevent or intervene early to lessen future risks of injury or death,” the authors concluded.

References:

1. American Academy of Pediatrics. Research shows significant association between emergency department visits for firearm and motor vehicle-related crashes. Eurekalert. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098767
2. Beyer M. Council on Injury, Violence, and Poison Prevention Program and Firearm Injury Prevention Special Interest Group. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.